Reproductive Health Fact Sheet
Investments in reproductive health, including family planning and maternal care, are essential for meeting the Millennium Development Goals.
Reproductive health conditions – including HIV/AIDS - are the leading cause of death and illness in women worldwide (15-44 years of age), and the second leading cause of death and illness when both men and women of reproductive age are taken into account.
Worldwide, an estimated 250 million years of productive life are lost every year as a result of reproductive health problems. The poor disproportionately bear the consequences of poor reproductive health, especially impoverished women and young people.
There are glaring disparities in access to reproductive health care between rich and poor, within and among countries.
Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries.
An estimated 529,000 women died from complications of pregnancy and childbirth in 2000.1
For every woman who dies, roughly 20 more suffer serious injury or disability
— between 8 million and 20 million a year.
A mother's death can devastating to the children left behind, who become vulnerable to poor health, poverty and exploitation without a mother's love and protection.
A mother's disability can diminish her contributions to both the family and the economy in the struggle against poverty.
Virtually all maternal deaths (99 per cent) occur in developing countries:
- Africa and Asia together account for 95 per cent of the world's maternal deaths.
- Less than 1 per cent (2,500) occurred in the developed regions. 2
National and regional averages conceal dramatic inequities in maternal mortality rates within countries. Vulnerable groups — such as indigenous, ethnic or other minorities
— often have significantly higher rates of maternal mortality. For instance, although only a small percentage (4 per cent) of all maternal deaths occurred in Latin America and the Caribbean, these deaths occurred disproportionately among indigenous peoples, which have extremely high maternal mortality ratios.
Maternal Mortality ratios per 100,000 live births, 2000
All women – rich or poor – face a 15 per cent risk of delivery complications. 3
The majority of maternal deaths are preventable through:
- family planning to reduce unintended pregnancies
- skilled attendance at all deliveries
- timely emergency obstetric care in all cases where complications arise
In industrialized countries, maternal deaths are rare because women have access to life saving care.
Limited progress on maternal mortality over the past two decades attests to the low value placed on saving women's lives and the limited voice women have in setting national priorities. The know-how for preventing maternal mortality is now available, but requires a major strengthening of health systems. It also requires promoting gender equality, especially the reproductive health and rights of women.
Major reductions in the number of deaths have taken place in countries with either low or moderate levels of maternal mortality. Similar progress, however, has not been made in countries where maternal mortality is high:
- Improvements were achieved in South-Eastern Asia, Northern Africa and Eastern Asia, while no change was seen in sub-Saharan Africa, where maternal mortality remains the highest.
- Though progress continues in Southern Asia, this region has the lowest level of professional care at birth in the world.
A growing number of countries, some with high poverty levels, have demonstrated what political leadership, combined with technical knowledge and resources, can accomplish. Countries successful in reducing maternal mortality include Bangladesh, Bolivia, China, Cuba, Egypt, Honduras, Indonesia, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia.
Success in Malaysia, Sri Lanka and Thailand is credited to significant investments in the training of midwives, beginning in the 1950s, and expanded access to skilled attendance at birth. Maternal deaths were halved in these countries every 7 to 10 years.
Lack of access to family planning is a major factor behind the 76 million unintended pregnancies every year in the developing world. 4 These lead to 19 million annual unsafe abortions, causing some 68,000 deaths.5
Research shows that one in ten pregnancies will end in an unsafe abortion, with Asia, Africa and Latin America accounting for the highest numbers.6
Access to safe and effective contraception reduces the incidence of induced abortion.
In several countries of Central and Eastern Europe, abortion rates declined rapidly with the establishment of family planning services and an increase in the availability of contraception. 7 In Romania, for example, abortion rates dropped dramatically from 52 to 11 per 1,000 women (aged 15 to 44) between 1995 and 1999.8
The presence of a skilled attendant at delivery increased significantly between 1990 and 2003, from 41 to 57 per cent, in the developing world as a whole.
- The greatest improvements occurred in South-Eastern Asia (from 34 to 64 per cent) and Northern Africa (from 41 to 76 per cent).
- The least change was observed in sub-Saharan Africa and Western Asia, both of which rose only 1 percentage point between 1990 and 2003.
Significant differences also exist both within and across countries. In every region, the presence of skilled birth attendants is lower in rural than in urban areas.
Wealth distribution is a major determinant of care during delivery:
- In Ethiopia, for example, the rich are 28 times as likely as the poor to have a skilled attendant present during delivery.9
- In India, the rich to poor ratio is 7 to 1. 10
- In Chad and Niger the difference is 14-fold or more. 11
Of the 130 million babies born every year, about 4 million die in the first 4 weeks of life—the neonatal period.12
Newborn deaths account for nearly 40 percent of all deaths in children under five. Within the neonatal period, mortality is very high in the first 24 hours after birth.13
Newborn deaths are closely related to the health of the mother and to whether she has skilled attendance at delivery and postpartum care. Malnutrition, resulting in premature and low-birth weight infants, is a major risk factor.
Early pregnancy is also a risk factor: Babies born to adolescent mothers are 1.5 times more likely to die before their first birthday than if they were born to older women. 14
Adolescent girls face the highest risk of premature delivery, a major factor in newborn deaths. Because their bodies are not fully mature, they are also at risk of obstructed labour, which often results in the infant's death.
Globally some three quarters of neonatal deaths happen in the first week after birth. 15
Almost all (99 per cent) neonatal deaths are in low- and middle-income countries, and about half occur in the home. 16
The highest numbers of neonatal deaths are in south-central Asia and the highest rates are generally in sub-Saharan Africa.
- In sub-Saharan Africa, less than 40 per cent of women deliver with skilled care and in South Asia the figure is less than 30 per cent. 17
- Across 40 countries with Demographic and Health Survey data, more than 50 per cent of neonatal deaths arose after a home birth with no skilled care between 1995 and 2003. 18
Family planning is a human right and is essential to women's empowerment. It is central to efforts to reduce poverty, promote economic growth, raise female productivity, lower fertility, and improve child survival and maternal health.
Family planning can prevent 20-35 per cent of all maternal deaths.19
By enabling smaller family sizes, family planning can help stabilize rural areas, slow urbanization, and balance natural resource use with the needs of the population.
Since reliable methods of family planning became available in the 1960s, the use of modern contraception has steadily risen to 54 per cent (and 61 per cent when traditional methods are taken into account) among all women currently married or in union.20 As a result, fertility rates continue to fall.
Access to contraception
Contraceptive use is uneven both among and within countries. It varies according to wealth, education, ethnicity, rural or urban residence and the strength of national family planning programmes:
- In Africa, only 20 per cent of married women use modern contraception.21 In some parts of the continent, the proportion drops to under 5 per cent.22
- Wealth distribution is a major determinant: On average, the poorest women are four times less likely to use contraception than the wealthiest: In some countries, the rate is 12 times lower.
In the developing world, the total fertility rate – average number of births per woman – has fallen from over 6 in the 1960s to under 3 per woman today.23
In the least developed countries, however, fertility rates remain high at five children per woman on average.24 Uganda, Afghanistan and the Niger each have a total fertility rate of over seven children per woman.
Nearly half of all people living with HIV are female, but as the epidemic worsens, the share of infected women and girls is growing.
Of the 17 million women between the ages of 15 and 49 are living with HIV, 98 per cent live in developing countries.25
Of all regions, sub-Saharan Africa continues to be the most devastated. No other region in the world approaches its HIV prevalence rates or displays such a disproportionate impact on women and girls:
- More than three–quarters (77 per cent) of all women living with HIV live in Sub-Saharan Africa.26
- Women and girls make up almost 57 per cent (over 13 million) of all people infected with HIV in the region.27
- Among girls aged 15–24, the difference is even more pronounced: In the worst- affected countries of Africa, recent national surveys show as many as three young women living with HIV for every young man. 28
The Asia and Pacific region could become the centre of the global AIDS pandemic in the next decade, with China and India , the world's most populous nations, facing a potential AIDS crisis.29 Factors affecting the spread of HIV among women and girls in the region are poverty, early marriage, trafficking, sex work, migration, lack of education, and gender discrimination and violence.
Eastern Europe and Central Asia
HIV prevalence has grown rapidly in this region. In 2003 alone, more than a quarter of a million people became infected. On average, women account for one third of people living with HIV in the region.30 However, according to various studies, their rates are increasing compared to men's.
In 2002 in the Russian Federation , 33 per cent of newly diagnosed infections were among women, compared to 24 per cent a year earlier.31
Latin America and the Caribbean
Some 2 million people between the ages of 15 and 49 are living with HIV in Latin America and the Caribbean . On average, women account for 36 per cent of all people with HIV in Latin America and 49 per cent in the Caribbean.32 In the Caribbean, young women are 2.5 times more likely to be infected than young men
The Arab States
HIV prevalence in the Arab States still low. In countries of this region, social and cultural norms limit the discussion of sexuality and reproductive and sexual health issues, and many countries have not developed prevention programmes.
High Income Countries
The percentage of women among adults living with HIV is rising in North America as well as in Western Europe . In North America, where the general availability of antiretroviral therapy would suggest that the epidemic is largely under control, women's prevalence rates jumped 5 per cent between 2001 and 2003, which is the largest increase among women in any region of the world.33